Sources and Amounts of Animal,Dairy, and Plant Protein Intake of US Adults in 2007–2010

Dietary guidelines suggest consuming a mixed-protein diet, consisting of high-quality animal, dairy, and plant-based foods. However, current data on the distribution and the food sources of protein intake in a free-living, representative sample of US adults are not available. Data from the National Health and Nutrition Examination Survey (NHANES), 2007–2010, were used in these analyses (n = 10,977, age ≥ 19 years). Several US Department of Agriculture (USDA) databases were used to partition the composition of foods consumed into animal, dairy, or plant components. Mean ± SE animal, dairy, and plant protein intakes were determined and deciles of usual intakes were estimated. The percentages of total protein intake derived from animal, dairy, and plant protein were 46%, 16%, and 30%, respectively; 8% of intake could not be classified. Chicken and beef were the primary food sources of animal protein intake. Cheese, reduced-fat milk, and ice cream/dairy desserts were primary sources of dairy protein intake. Yeast breads, rolls/buns, and nuts/seeds were primary sources of plant protein intake. This study provides baseline data for assessing the effectiveness of public health interventions designed to alter the composition of protein foods consumed by the American public.     

Treatment Practices,Outcomes, and Costs of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis,United States, 2005–2007

To describe factors associated with multidrug-resistant (MDR), including extensively-drug-resistant (XDR), tuberculosis (TB) in the United States, we abstracted inpatient, laboratory, and public health clinic records of a sample of MDR TB patients reported to the Centers for Disease Control and Prevention from California, New York City, and Texas during 2005–2007. At initial diagnosis, MDR TB was detected in 94% of 130 MDR TB patients and XDR TB in 80% of 5 XDR TB patients. Mutually exclusive resistance was 4% XDR, 17% pre-XDR, 24% total first-line resistance, 43% isoniazid/rifampin/rifabutin-plus-other resistance, and 13% isoniazid/rifampin/rifabutin-only resistance. Nearly three-quarters of patients were hospitalized, 78% completed treatment, and 9% died during treatment. Direct costs, mostly covered by the public sector, averaged $134,000 per MDR TB and $430,000 per XDR TB patient; in comparison, estimated cost per non-MDR TB patient is $17,000. Drug resistance was extensive, care was complex, treatment completion rates were high, and treatment was expensive.     

The Growth of Managed Care and Changes in Physicians' Incomes, Autonomy, and Satisfaction, 1991–1997

Using survey data collected in 1991 and 1997 from a panel of almost 1,500 physicians, we analyzed the relationship between changes in physicians' incomes, practice autonomy, and satisfaction, and the growth of HMOs and physicians' perceived financial incentives. Both the growth of HMOs and financial incentives to reduce services were significantly related to lower income growth, reductions in practice autonomy, and decreases in satisfaction. Changes in income and autonomy were both positively and significantly related to changes in satisfaction. Controlling for changes in income and autonomy, HMO growth was no longer significantly related to changes in satisfaction. Having a perceived financial incentive to reduce services remained a negative and significant determinant of the change in career satisfaction.     

Association of Melioidosis Incidence with Rainfall and Humidity,Singapore, 2003–2012

Soil has been considered the natural reservoir for the bacterium Burkholderia pseudomallei, which causes melioidosis. We examined 550 melioidosis cases that occurred during a 10-year period in the highly urbanized city of Singapore, where soil exposure is rare, and found that rainfall and humidity levels were associated with disease incidence.     

Organochlorines and reproductive success of birds in orchard and non-orchard areas of central British Columbia,Canada, 1990–91

Most orchards in British Columbia, Canada and the northwestern United States received substantial applications of DDT in the mid-1940s through the early 1970s. Bird eggs were collected from orchard and non-orchard areas in the Okanagan Valley fruit-growing region of central British Columbia during 1990 and 1991 to determine levels of DDT, DDE, and other organochlorines. American robin (Turdus migratorius) eggs from orchard areas contained extremely high levels of both DDE (up to 103 mg/kg) and DDT (up to 26 mg/kg). For robins, tree swallows (Tachycineta bicolor), and house wrens (Troglodytes aedon), levels of DDT and DDE in eggs were significantly higher in orchard habitats than in non-orchard habitats. These data suggest that Okanagan Valley birds were acquiring DDT and DDE burdens locally, and not on their Latin American wintering grounds, as has been previously hypothesized. Ratios of DDE to DDT in robin eggs were quite low (<10), implying that DDT is not breaking down readily in orchard soils and/or that orchards have been receiving recent illicit applications of DDT. There was no evidence of lower reproductive success among tree swallows, house wrens, and bluebirds that nested in orchard versus non-orchard habitats, so the levels of DDT and DDE contained in their eggs (0.1 and 5 mg/kg, respectively) were probably not deleterious. There was no difference in reproductive success of robins nesting in conventional versus organic orchards. Although we did not have a sufficient sample of non-orchard robin nests, comparisons with data on reproductive success in the literature indicates that despite exceedingly high DDT and DDE concentrations, reproduction was not affected. Levels of other organochlorines (dieldrin, heptachlor epoxide, PCBs) in eggs were low, and usually below the minimum detectable threshold. The high DDE concentrations in these eggs from the Okanagan valley indicate that DDE body burdens of passerines nesting there would probably present a considerable toxic hazard to predators, particularly birds of prey.     

Migration and Persistence of Human Influenza A Viruses,Vietnam, 2001–2008

Understanding global influenza migration and persistence is crucial for vaccine strain selection. Using 240 new human influenza A virus whole genomes collected in Vietnam during 2001–2008, we looked for persistence patterns and migratory connections between Vietnam and other countries. We found that viruses in Vietnam migrate to and from China, Hong Kong, Taiwan, Cambodia, Japan, South Korea, and the United States. We attempted to reduce geographic bias by generating phylogenies subsampled at the year and country levels. However, migration events in these phylogenies were still driven by the presence or absence of sequence data, indicating that an epidemiologic study design that controls for prevalence is required for robust migration analysis. With whole-genome data, most migration events are not detectable from the phylogeny of the hemagglutinin segment alone, although general migratory relationships between Vietnam and other countries are visible in the hemagglutinin phylogeny. It is possible that virus lineages in Vietnam persisted for >1 year.     

Molecular Typing and Epidemiology of Human Listeriosis Cases,Denmark, 2002–2012

Denmark has a high incidence of invasive listeriosis (0.9 cases/100,000 population in 2012). We analyzed patient data, clinical outcome, and trends in pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) of Listeria monocytogenes strains isolated in Denmark during 2002–2012. We performed 2-enzyme PFGE and serotyping on 559 isolates and MLST on 92 isolates and identified some correlation between molecular type and clinical outcome and patient characteristics. We found 178 different PFGE types, but isolates from 122 cases belonged to just 2 closely related PFGE types, clonal complex 8 and sequence type 8. These 2 types were the main cause of a peak in incidence of invasive listeriosis during 2005–2009, possibly representing an outbreak or the presence of a highly prevalent clone. However, current typing methods could not fully confirm these possibilities, highlighting the need for more refined discriminatory typing methods to identify outbreaks within frequently occurring L. monocytogenes PFGE types.     

The Forms,Distribution, and Risk Assessment of Sulfonamide Antibiotics in the Manure–Soil–Vegetable System of Feedlot Livestock

Bulletin of Environmental Contamination and Toxicology - Manure, soil, and vegetable samples were collected from different-sized livestock farms in Xinxiang, China. The residues of sulfadiazine,...     

The prevalence and trends of overweight and obesity among Lithuanian adults, 1994–2012

Objectives

The aim of this study was to assess trends in body mass index (BMI) and in the prevalence of overweight and obesity among Lithuanian adults between 1994 and 2012.

Study design

The data were obtained from ten biennial cross-sectional surveys of Lithuanian Health Behaviour Monitoring. For every survey, a nationally representative random sample aged 20–64 was drawn from the National Population Register. Response rates ranged from 51% to 74%. In total, 7968 men and 10 695 women reported their weight and height.

Methods

All surveys used the same methodology and questionnaires, which were sent by mail. Self-reported weight and height were used to calculate body mass index (BMI). Overweight was defined as BMI ≥25 kg/m² and obesity – as BMI ≥30 kg/m².

Results

The most prominent increase in mean BMI was observed in the oldest age group (55–64 years) of men. A decrease in mean BMI occurred in the youngest age groups (20–34 and 35–44 years) of women. The proportion of overweight men increased from 47.0% to 62.5%, and the proportion of obese men – from 10.6% to 19.0%. In women, the prevalence of obesity was similar in the first and in the last survey (19.0% and 20.5% respectively).

Conclusions

Over the study period, the difference in the prevalence of overweight and obesity increased between the age groups, because of age-related trends. Our data emphasize the need for a national strategy for obesity prevention and control targeting the whole population, particularly men and older women.     

Rise and fall of asthma-related mortality in Italy and sales of β2-agonists, 1980–1994

We performed this study with the aims of describing the trend of asthma-related mortality in Italy between 1980 and 1994, and to evaluate the relationship between sale estimates of ₂-agonists drugs and mortality from asthma. For asthma mortality we used data provided by National Institute of Statistics, for sale estimates of ₂-agonists we used data provided by IMS HEALTH. We calculated the gender specific age-standardized incidence rates of asthma-related deaths for all ages and for age classes. We found that estimates for asthma-related mortality steadily increased between 1980 and 1987 in both sexes, and thereafter decreased. In people, aged between 34 and 64 and over 64, death rates in males were significantly higher than in females while the rates in those aged less than 34, were mostly similar in both gender. The overall exposure to ₂-agonists (alone and in combination) increased from 1980 to 1990, remained stable between 1990 and 1993, and increased steeply in 1994. We conclude that asthma-related death rates have declined since the mid-1980's. This decline has been more pronounced in males and in the older ages, while the rates in younger patients of both genders have remained nearly unchanged. Our data do not substantiate the hypothesis of an increased risk of asthma-related mortality associated to the use of inhaled ₂-agonists in general nor fenoterol or salbutamol in particular.     

Mortality rates and causes of death in a cohort of HIV-infected and uninfected women, 1993–1999

HIV/AIDS-associated and non-HIV/AIDS-associated death rates and causes of death between 1993 and 1999 were examined in 885 HIV-infected women and 425 uninfected women of the HIV Epidemiology Research Study cohort. Causes of death were determined by review of death certificates and the National Death Index. Adjusted bazard ratios were calculated for mortality risk factors. In the 885 HIV-infected women and 425 uninfected women, 234 deaths and 8 deaths, respectively, occurred by December 31, 1999. All-cause death rates in the HIV-infected women were unchanged between the pre-HAART (1993–1996) and HAART eras (1997–1999) —5.1 versus 5.4 deaths per 100 person-years (py). AIDS as a cause of death decreased from 58% of all deaths in 1996 to 19% in 1999, while HAART use increased to 42% by the end of 1999. In spite of the modest proportion ever using HAART, HIV-related mortality rates did decline, particularly in women with CD4+cell counts less than 200/mm³. Drug-related factors were prominent: for the 129 non-AIDS-defining deaths, hepatitis C positivity (relative bazard [RH] 2.6, P<0.001) and injection drug use (RH 1.7, P=0.02) were strong predictors of mortality, but were not significant in the Cox model for 105 AIDS-defining deaths (RH 0.9, P>30 and RH 0.7, P>.30, respectively. The regression analysis findings, along with the high percentage of non-AIDS deaths attributable to illicit drug use, suggest that high levels of drug use in this population offset improvements in mortality from declining numbers of deaths due to AIDS. Supported by cooperative agreements No. U64/CCU106795, U64/CCU206798, U64/CCU306802, and U64/CCU506831 with the Centers for Disease Control and Prevention including supplementary support from the National Institute on Drug Abuse. Centers for Disease Control and Prevention, Division of HIV     

Infectious Causes of Encephalitis and Meningoencephalitis in Thailand, 2003–2005

Acute encephalitis is a severe neurologic syndrome. Determining etiology from among ≈100 possible agents is difficult. To identify infectious etiologies of encephalitis in Thailand, we conducted surveillance in 7 hospitals during July 2003–August 2005 and selected patients with acute onset of brain dysfunction with fever or hypothermia and with abnormalities seen on neuroimages or electroencephalograms or with cerebrospinal fluid pleocytosis. Blood and cerebrospinal fluid were tested for >30 pathogens. Among 149 case-patients, median age was 12 (range 0–83) years, 84 (56%) were male, and 15 (10%) died. Etiology was confirmed or probable for 54 (36%) and possible or unknown for 95 (64%). Among confirmed or probable etiologies, the leading pathogens were Japanese encephalitis virus, enteroviruses, and Orientia tsutsugamushi. No samples were positive for chikungunya, Nipah, or West Nile viruses; Bartonella henselae; or malaria parasites. Although a broad range of infectious agents was identified, the etiology of most cases remains unknown.     

The relative contribution of work exposure, leisure time exposure, and individual characteristics in the onset of arm–wrist–hand and neck–shoulder symptoms among office workers

Purpose

To identify the risk factors for the onset of arm–wrist–hand and neck–shoulder symptoms among office workers and to estimate the relative contribution of these risk factors by calculating Population Attributable Fractions (PAFs).

Methods

A prospective cohort study was conducted among 1951 office workers with a follow-up duration of 2?years. Data on self-reported risk factors were collected at baseline and after 1?year of follow-up. Every 3?months, the occurrence of upper extremity symptoms was assessed using questionnaires. PAFs for individual risk factors were estimated based on Rate ratios (RRs) obtained from Poisson regression using Generalized Estimation Equations.

Results

Previous disabling symptoms were identified as the most important risk factor for the onset of arm–wrist–hand and neck–shoulder symptoms. Modifiable risk factors for arm–wrist–hand symptoms with relatively large PAFs were: at least 4?h per day of self-reported computer use at work, high level of overcommitment, and low task variation and for neck-shoulder symptoms: supporting the arms during keyboard use and at least 4?h per day of self-reported mouse use at work. Compared to having 0 or 1 risk factor, the RR for arm–wrist–hand symptoms increased to 6.2 (95% CI 3.7–10.5) for having 5–7 potentially modifiable risk factors and for neck–shoulder symptoms to 3.0 (95% CI 2.1–4.4) for having 4 or 5 potentially modifiable risk factors.

Conclusion

Preventive interventions at the population level should be aimed at changing modifiable risk factors with large PAFs. At the individual level, preventive interventions should be aimed at changing multiple modifiable risk factors simultaneously.     

Association of geomagnetic disturbances and suicides in Japan, 1999–2010

Objectives

Previous studies have shown a positive relationship between geomagnetic disturbances and an increased incidence of suicide. The Japanese suicide rate is the ninth highest in the world, but there have been no reports examining the relationship between geomagnetic disturbance and the number of suicides, and, therefore, this paper examines this relationship.

Methods

The number of Japanese suicides per month from January 1999 to December 2010 was obtained, and it was found that a total of 262,596 males and 102,539 females committed suicide during this period. To adjust the other factors which affect the number of suicides, a multiple linear regression analysis with backward elimination was carried out, with the monthly number of suicides as the response variable and the monthly mean K index value, monthly mean number of sunspots, monthly mean unemployment rate, proportion of elderly people (%), monthly mean air pressure (hPa), monthly mean air temperature (°C), monthly mean humidity (%), and monthly mean day length (h) as the explanatory variables.

Results

In the multiple linear regression analysis for males, the monthly mean K index value was associated with the monthly number of suicides, but in females, the monthly mean K index value was not associated with the monthly number of suicides.

Conclusion

In this study, we generated a hypothesis that geomagnetic disturbances may trigger male suicides.     

Stage-specific incidence rates and trends of prostate cancer by age,race, and ethnicity,United States, 2004–2014

Purpose

Current literature shows different findings on the contemporary trends of distant-stage prostate cancer incidence, in part, due to low study population coverage and wide age groupings. This study aimed to examine the stage-specific incidence rates and trends of prostate cancer by age (5-year grouping), race, and ethnicity using nationwide cancer registry data.

Socioeconomic Characteristics,Dietary and Lifestyle Patterns,and Health and Weight Status of Older Adults in NHANES, 1999–2002: A Comparison of Caucasians and African Americans

There are disparities among older Caucasian and African American adults in many areas. The study used data from the National Health and Nutrition Examination Survey conducted from 1999 to 2002 and compared the self-reported dietary intakes, physical activity, and economic and health status of Caucasian (N = 1,398) and African American (N = 354) adults aged 65 years and older. Regression models and t-tests (α = 0.05) were used for comparisons. More African Americans than Caucasians lived in low-income households (40.4% vs. 21.3%), lived in households that were not fully food-secure (15.6% vs. 4.9%), watched five or more hours of television (34% vs. 20%), and were told that they had diabetes (10% vs. 4%) or high blood pressure (67 % vs. 52 %). They consumed 253 fewer calories than Caucasians. About 75 % of African American women were overweight. Our findings indicate that for those greater than 65 years of age, low-income African Americans are at a greater risk for poor nutrition and chronic health conditions than Caucasians.     

Chronic,Inhalation Exposure of Rats,Rabbits , and Monkeys to 1 , 2 , 4–Trichlorobenzene

Three groups composed of rats, rabbits, and monkeys were exposed for 26 weeks to 1,2,4-trichlorobenzene (-TCB), and one group of each species was used as a control group. TTie nominal exposure concentrations of 1,2,4-TCB were 25.0, 50.0, and 100.0 ppm. Pulmonary function and operant behavior tests in monkeys, ophthalmoscopic examinations in rabbits and monkeys, and measurement of body weights and hematologic and serum biochemical determinations in all species were conducted before and during the exposure period. At termination of 1, 3, and 6 months of exposure, microscopic examination of selected rat tissues was performed. Microscopic changes were seen in the parenchymal cells of livers and kidneys from all groups of rats exposed to 1,2,4-TCB when sacrificed after 4 and 13 weeks of exposure, but no exposure-related abnormalities or other effects were seen after 26 weeks of exposure in any species.     

Safety of the 2010–11, 2011–12, 2012–13, and 2013–14 seasonal influenza vaccines in pregnancy: Birth defects,spontaneous abortion,preterm delivery,and small for gestational age infants,a study from the cohort arm of VAMPSS

IntroductionThere is a need for pregnancy safety information overall and for each seasonal formulation of the influenza vaccine.MethodsAs part of the cohort arm of the Vaccines and Medications in Pregnancy Surveillance System, vaccine-exposed and unexposed women in the U.S. or Canada were recruited during pregnancy in the 2010–2014 vaccine seasons and followed to pregnancy outcome. For the four seasons combined, crude and adjusted relative risks (RRs) were estimated with 95% confidence intervals (CIs) for major birth defects overall and infants small for gestational age. Crude and adjusted hazard ratios (HRs) were estimated with 95% CIs for spontaneous abortion and preterm delivery. Specific influenza season subanalyses were also conducted.ResultsOf 1730 women, 1263 were exposed to an influenza vaccine and 467 were unexposed to any influenza vaccine. Among pregnancies with first-trimester exposure excluding lost-to-follow-up, 26/457 (5.7%) resulted in an infant with a major birth defect compared to 13/427 (3.0%) in the unexposed (RR 1.87, 95% CI 0.97, 3.59). No specific pattern of defects was evident in the vaccine-exposed cohort. The overall risk of spontaneous abortion was not elevated (HR 1.09, 95% CI 0.49, 2.40). Adjusted HRs for preterm delivery approximated 1.0 (adjusted HR 1.23, 95% CI 0.75, 2.02). RRs for small for gestational age infants on weight, length and head circumference ranged from 1.19 to 1.49 with all CIs including 1. Season-by-season analyses resulted in variation by season; however, estimates were based on small numbers.ConclusionsCombining the 2010–2014 influenza seasons, we found a moderately elevated RR for major birth defects overall, but no evidence of a specific pattern; 95% CIs included 1, and this finding could be due to chance. In the combined seasons, we found no meaningful evidence of an increased risk for spontaneous abortion or preterm delivery following exposure to the seasonal influenza vaccine.